Revisiting lip shave: a solution for disorders of the vermilion border

Actinic keratosis, leukoplakia, carcinoma in situ, and superficially invasive carcinomas of the lower lip are caused mainly by the cumulative effects of exposure of the vermilion of the lower lip to ultraviolet radiation. Current treatments all have limitations: cryosurgery or electrosurgery is suitable to treat only focal lesions; topical chemotherapy, which is an option for diffuse actinic damage, yields unreliable results; and laser treatment fails to rejuvenate the vermilion. However, “lip shave”, which involves full-thickness excision of the damaged vermilion and reconstruction with an advancement labial mucosal flap, will produce a fresh mucosal lining to the vermilion border. We describe our experience of the technique and evaluate the functional and aesthetic outcomes in 20 patients treated between January 2011 and January 2016. The follow-up period ranged from 24 to 60 months. Three-quarters of the patients had dysplasia or superficially invasive malignancy. Resected lesions were about 63 mm long, 13.7 mm wide, and 3.9 mm deep. No patients had recurrence or secondary lesions during follow up, functional disturbance was minimal, and the cosmetic outcome pleasing. Lip shave can efficiently reconstruct the vermilion of the lower lip with minimum deformity.     

Percutaneous treatment of orofacial vascular malformations

The aim of this study was to evaluate the efficacy of fluoroscopy-guided percutaneous injection of bleomycin as the primary treatment for low-flow vascular malformations. A total of 34 patients (mean (range) age 24 (8–51) years) with orofacial vascular lesions were treated in the Department of Interventional Radiology and Maxillofacial Surgery. There were 20 low-flow venous malformations, 11 lymphatic malformations, and three of mixed type. All patients were treated by fluoroscopy-guided percutaneous injection of a mixture of bleomycin (mean (range) 15 (5–15) mg) and a radio-opaque agent (Ultravist^® (iopromide), Bayer)/session. The number of sessions ranged from one to six. The clinical response was complete in 21 patients, obvious in nine, and of clinical benefit in four. Patients were reviewed within the first week, third week, and at three-month periods until 24 months. There were no serious complications such as pulmonary fibrosis. Fluoroscopy-guided intralesional injection of bleomycin should be considered as the first-line treatment for lymphatic malformations because it is effective and reliable with few complications.     

Depression or resilience? A participatory study to identify an appropriate assessment tool with Kanien’kéha (Mohawk) and Inuit in Quebec

Purpose

We present a study on selection of a psychometric scale to be clinically used among Indigenous people with depression. Our aim was to select a psychometric tool for cultural adaptation with Mohawk and Inuit in Quebec.

Methods

We selected three depression scales and three protective factor scales based on: strong validity for psychometric properties, evidence for good psychometric qualities across translations, avoidance of cognitively complex sentences, brevity, and clarity. We submitted the scales for consultation, and followed qualitative participatory methods with Mohawks of Kahnawake and Inuit from Nunavik living in an urban environment. We collected data through ten focus groups with advisory committees, and carried out a thematic analysis of the information.

Results

The advisory groups considered the measurement scales to be unsafe. The major components that hindered their acceptance were: numeric rating, self-evaluation (versus supportive interaction), and a focus on symptoms rather than supportive factors. The participants preferred the Growth and Empowerment Measure due to its empowering approach. They voiced that it is necessary to develop a culturally sensitive and safe tool which facilitates interactions between the person and the practitioner.

Conclusion

This project provides valuable information about the perspectives of local Indigenous peoples regarding mental health and factors of empowerment and resilience. The ideal tool should be flexible in terms of the content and its use as compared to the conventional psychometric strategies. A tool developed with the Indigenous perspective on wellbeing could be used in psychological and psychiatric intervention as well as in social and community services.

     

Recent advances in the management of cutaneous malignant melanoma: our case cohort

Decades of research into the management of cutaneous malignant melanoma have proven it to be a ‘tough nut to crack’, and its incidence has continued to increase over the last 30 years. Surgery remains a gold standard for early-stage melanoma with five-year survival of 98% for stage I disease, and 90% for stage II. Nonetheless, patients with stage III disease are at a higher risk, resulting in local recurrence as well as distant metastasis. Research regarding the control of metastatic malignant melanoma of the head and neck has evolved. Currently the search is on to understand metastatic malignant melanoma as a heterogeneous disease both at the molecular and clinical level. This paper focuses on the latest systemic therapy for metastatic disease of the head and neck, including cytotoxic chemotherapy, immunotherapy, and target therapy. The new eighth edition of tumour staging, and the sequelae for malignant melanoma, sentinel lymph node biopsy (SLNB), surgical intervention, and its benefits and shortfalls, are discussed. Also, the outcome of our cohort series of patients with metastatic cutaneous malignant melanoma who were treated with systemic combination therapy in Dorset is presented.     

Laboratory coherent-scatter analysis of intact urinary stones with crystalline composition: a tomographic approach

Knowledge of urinary stone composition and structure provides important insights in guiding treatment and preventing recurrence. No current method can successfully provide information relating structure and composition of intact stones. We are developing a tomographic technique that uses measures of coherently scattered diagnostic x-rays to yield stone composition. Coherent-scatter (CS) properties depend on molecular structure and are, therefore, sensitive to material composition. Powdered, amorphous or polycrystalline materials with no significant orientation produce circularly symmetric CS patterns. However, in materials with preferred crystallite orientation, like urinary stones, bright spots in CS patterns are observed. This compromises a composition analysis based on comparing CS measurements from calculi to a library of CS signatures from powdered chemicals. We show that a computed tomographic reconstruction of CS measurements using filtered backprojection (CSCT) effectively eliminates bright spots and yields CS patterns equivalent to powdered materials. This allows for direct comparison with a powdered chemical reference library to establish composition. Validation is achieved through a tomographic CS analysis of an aluminium (Al) rod phantom. Much like calculi, CS patterns from a solid polycrystalline Al rod exhibit diffraction spots, absent in the ring-like Al powder CS pattern. We show that the reconstructed Al CS cross-section is equivalent to its powdered counterpart and results in clearly defined composition images. The potential of CSCT to identify stone composition is demonstrated through images of intact stones deemed chemically pure by infrared spectroscopy. Computed tomographic reconstruction of CS signals allowed the generation of composition maps, showing the distribution of stone components. These images provide strong evidence that current laboratory techniques risk missing critical stone components due to inadequate sampling. This is of particular importance since follow-up treatments are based on these composition analyses. CS analysis can distinguish common stone components and can provide topographic composition maps of intact stones. Such details offer invaluable clinical information regarding stone formation, treatment and follow-up, and thus support the development of CS analysis as a laboratory stone analysis technique.     

Upper face rejuvenation

The area of the upper face occupies about one third of the surface area of the whole face. The anatomical landmarks involve the forehead, brow, glabella and the upper lids. Gravitational and intrinsic changes, as well as familial problems affect the aesthetics of the upper face. The author describes the anatomy and pathophysiology of ageing and the importance of making a correct diagnosis. Surgical and non surgical solutions are discussed. The concept of the beneficial effect of antioxidants such as curcumin is introduced. The efficacy of non ablation laser in dermal rejuvenation is explained. The author aims to impart a thorough understanding of the different surgical and non-surgical options for rejuventating the upper face to achieve an unoperated outcome with a healthy looking forehead.     

Granulocytic sarcoma of the lips: report of an unusual case.

Granulocytic sarcoma (GS) is a rare localized, extramedullary tumor composed of immature cells of granulocyte series. It is capable of marked local tissue destruction. This condition can be a precursor of acute myeloid leukaemia by months or years making its diagnosis critical. Its occurrence has been described in multiple sites including skin, lymph nodes, bone, and visceral organs. It is extremely rare in the oral cavity and only 30 cases have been reported in the literature to date and often as a lump in the gingiva, palate, and extraction sockets. We describe the first reported case of GS presenting as a solitary lump in the lip and review the pertinent literature.